低频重复经颅磁刺激对抑郁症患者BDNF及认知功能的影响

目的探讨低频重复经颅磁刺对抑郁症患者认知功能以及脑源性神经营养因子(BDNF)的影响,并进一步分析治疗过程中BDNF的改变与认知功能改变的关系.方法连续入组抑郁症患者150例,按照就诊号将其随机分为刺激组和伪刺激组,刺激组给予4周的低频重复经颅磁刺治疗,伪刺激组给予同等程度的伪刺激,在治疗前和治疗4周后检测血浆中的BDNF的含量,同时用汉密尔顿抑郁量表(HAMD)评定患者的抑郁症状,运用重复性成套神经心理状态测验(RBANS)评定患者的认知功能水平,收集并整理数据.结果刺激组和伪刺激组治疗前HAMD总分、RBANS总分以及BDNF水平差异无统计学意义(P>0.05);治疗4周后刺激组和伪刺激组HAMD总分低于治疗前,RBANS总分和BDNF高于治疗前(P<0.05);刺激组HAMD总分、RBANS总分以及BDNF差值高于伪刺激组(P<0.05);BDNF差值与HAMD总分、RBANS总分差值呈显著正相关(r=0.375,0.314,P<0.05),BDNF差值可以分别解释HAMD总分差值和RBANS总分差值变异的21.20%和17.30%(P<0.05).结论低频重复经颅磁刺激可以显著改善抑郁症患者的认知功能和改变血浆中BDNF的含量,在rTMS治疗过程中体内BDNF含量的变化可能与认知功能的改善有关.

Objective To explore the effect of low frequency repetitive transcranial magnetic stimulation(rTMS)on cognitive function and brain-derived neurotrophic factor(BDNF)in patients with depression,and further analyze the relationship between BDNF changes and improvement of cognitive function during treatment. Methods A total of 150 consecutive patients with depression were randomly divided into real rTMS group and sham rTMS group according to the number of visits. The patients in real rTMS group were treated with 1HZ rTMS for 4 weeks,while the patients in sham rTMS group group were given the same degree of pseudo stimulation. The plasma level of BDNF and the score of Hamilton Depression Scale (HAMD)and Repeatable Battery for the Assessment of Neuropsychological Status(RBANS)were measured before and after 4 weeks’ treatments in patients with depression. Results There was no statistical difference between the real rTMS group and sham rTMS group about total score of HAMD, the total score of RBANS and the plasma level of BDNF before the treatment(P>0.05). After 4 weeks treatment,the HAMD total score of real rTMS group and sham rTMS group were lower than that before treatment,while the RBANS total score and plasma level of BDNF was significantly higher than that before treatment(P<0.05). The changes of HAMD total score,RBANS total score and the plasma level of BDNF in the real stimulation group were much higher than those of the sham rTMS group(P<0.05). The changes of BDNF positively correlated with the changes of HAMD total score and RBANS total score(r=0.375,0.314,P<0.05),that could explain 21.20% and 17.30% of the changes of HAMD total score and RBANS total score respectively(P<0.05). Conclusion Low frequency repetitive transcranial magnetic stimulation can significantly improve the cognitive function of patients with depression and change the content of BDNF in plasma. The change of BDNF content during rTMS treatment may be related to the improvement of cognitive function.